<form action="/" method="POST">
    <input type="hidden" name="act" value="get_unblocked_email" >
    <div class="logo-form">
        <label for="input-login">Enter you email for unblocked account</label>
        <div class="login-input">
            <input type="text" name="data[email]">
        </div>
        <div class="submit-login">
            <input type="submit" value="Send">
        </div>
        <div class="login-form-unblocked-link">
            <a href="/">Back to login</a>
        </div>
    </div>
</form>

